Keys to picking the right EHR…or optimizing the one you have

Electronic health records. Today they’re becoming virtually essential to delivering and documenting best-patient care, meeting quality requirements and ensuring your practice receives every dollar it rightfully has earned. But choosing the wrong EHR or implementing and using one improperly can cost a provider or practice millions and even cause it to close its doors.

In Medical Economics’ fifth survey of physician satisfaction with their practice’s EHR released in October, a majority of practices may now be using EHRs, but a greater percentage of them remain dissatisfied. Is that because (A) they made a bad choice, (B) implemented workflows and templates that weren’t right for their specialty or specific practice, or (C) just didn’t embrace the change?

As it turns out, it’s (D) — all of the above.

That’s borne out by the experience of Advantum Health’s EHR Optimization team which — depending on the practice’s needs — provides a broad range of EHR-related consulting and training services, from helping select a new system to optimizing some or all of an existing implementation.

As Advantum’s director of implementation, I stress that the success of an EHR directly supports patient care and the revenue cycle management side of the business. “Not all systems are right for all specialties or subspecialties…or specific practices and their workflows. Similarly, all consultants don’t have experience with the system you’ve installed or may be considering. Because of the large number of implementations we’ve done across so many practice settings, we leverage the lessons learned to show new clients what’s the best and easiest way to proceed with change, and stop them from making some of the costly mistakes that others have made.”

Advantum offers the following suggestions for maximizing workflows, buy-in and bottom-line revenue through EHR selection and optimization:

Decide what you need

If you’re a primary care physician, for example, you know how important it is to properly record and track immunizations and referrals. If you’re participating in special case studies, you need to extract data to submit it to a registry. Some states have syndromic surveillance; what systems are best for that? Know which systems are connected/interfaced with your principal external laboratories. If you work with area hospitals, which EHR meets your needs and best integrates with the hospitals’ systems so you can share and access patient data? This may not be so important if you’re the only physician in a rural area 30 miles away from the nearest hospital, but it’s essential if you have multi-hospital privileges in a densely populated area. Knowing what systems you need to share data with, hopefully bi-directionally, is essential. This also is essential and mandated with Stage 3 of meaningful use. Also, remember that some hospitals participate in a free electronic health exchange (EHX), so if you’re aware of those in your area and can choose the EHR that best connects to their systems, it will make data sharing much easier.

The same is true of what equipment you use; if you’re a cardiologist, it dramatically simplifies your workflow if EKG data goes directly from the machine into the patient’s EHR. These types of connections makes life easier for the practice and helps ensure that information is available when, where and how it’s required to deliver care and avoid expensive delays and unnecessary duplication of tests or procedures. And since that connectivity is rapidly becoming a reimbursement requirement in quality payment programs of EHR implementation in the U.S., you’re killing two birds with the same stone.

Focus on the new system

Once you’ve selected a system, don’t spend a lot of time comparing it to the old one. For all its faults, your old system is more familiar, and there’s a training and learning curve for the new system as part of the change-management process. Focus on why you chose your new system and what, and how, it can help you become more efficient and effective.

Advantum’s team helps through the entire process of configuring the providers in the system, ensuring all data is captured and imported — patient demographics, referral physician data, insurance information, etc. Practices should be walked through the process of how the front office can work efficiently as the practice’s critical starting point for information-gathering. On the backend, a consulting team such as ours works with the billing, coding and credentialing staff to ensure that among other things, all frequently used codes are set up as part of templates to streamline processes and prevent delays or errors during handoffs.

Involve all players

In both selection and implementation, everyone from the clinical staff to the front- and back-office teams need to provide input. This brings you valuable insight throughout the process that might otherwise be missed, and gains their buy-in to new workflows and processes. Everyone feels like they have value, and that they’re a key player. It becomes everyone’s project…not just IT’s. And if your consulting team can work with a tech-savvy partner at the practice such as an administrator who can articulate what the current bottlenecks and other problem areas are, that is invaluable. If your team can articulate problem areas, it’s far easier for a consultant to resolve them versus digging to find your sticking points.

Look at your patient demographics

When implementing a new EHR today and with a focus towards automating routine tasks, typically check-in kiosks or tablets integrated with the EHR are also chosen and rolled out. But patient acceptance depends not only on education (and occasional hand-holding) but an understanding of your patient population. If you’re a pediatrician, parents are likely to be tech-savvy and embrace the new tools. Senior patients — even those who routinely use a computer — may be lonely and prefer human interaction over the new tools. These patients also may not be able to stand long enough to use a kiosk. Make the best decision you can, both for data integration with your new EHR and keeping your patients in mind.

Work hand in glove with the EHR company

Although some companies such as Advantum have broad experience that covers most EHRs, no one knows their system’s strengths and flaws better than the company itself. They have expertise in configuring their system, its templates, quality measures and other requirements for meaningful use/MIPS most efficiently. As consultants, we leverage their knowledge base.

Right people, right tasks, right permissions

In any EHR optimization process, ensure that the right people are designated to perform the appropriate tasks, and set proper permission levels for viewing and editing in the new system. Non-medical front-office staff, for instance, need to view certain clinical data to perform their role, but shouldn’t have the ability to change clinical notes in the EHR; that can cause errors and compliance issues. When setup properly as per the role, the system can provide them with the information they need from the note, but without requiring (or allowing) them to access the system’s clinical side to get it. That requires fewer clicks and is much more efficient. And safer.

Automate as much as possible

That seems like a no-brainer, but there are so many things that can be automated within the latest-generation EHRs…from insurance eligibility verification, appointment reminder calls, coding edits, billing rules and more. Evaluate your system with this in mind, and implement as much integrated automation as the system can handle. Your staff will thank you for it, and you’ll create time for seeing more patients with little to no additional resources.

Get referrals from trusted colleagues

Finally, seek out your colleagues for their insights. Much of Advantum’s business comes from referrals from current customers, who are typically very glad to share their experience and satisfaction with their colleagues who are considering which partner can best help them select or optimize an EHR. Particularly if they’re from your specialty and region, their experiences can be particularly helpful as you prepare to select or enhance your EHR.